What a GP should know about Chiropractic

Chiropractic is a health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal manipulation or adjustment (World Federation of Chiropractic, 1999)

Chiropractic is a profession and not a treatment. Manipulation is widely used but this is only one of the therapeutic interventions employed by chiropractors. Exercises, advice on lifestyle and ergonomics, and counselling on pain beliefs and understanding form important parts of most patients’ treatments. Modalities such as ultrasound, acupuncture analgesia, massage and muscle stretching are also likely to be employed.

Chiropractic is a state registered profession controlled by the General Chiropractic Council (GCC). As such all chiropractors are responsible and legally accountable for the care they provide.

Referral to a chiropractor. Jane O’Brien, Head of the Standards Section at the GMC has confirmed to us that since the formation of the GCC, a GP referring a to a chiropractor would retain no more responsibility for care the patient received than they would on referring to a consultant within the NHS.

The reference provided for this is the GMC publication Good Medical Practice (2001); Paragraph 47; Delegation and Referral; ‘…you must be satisfied that any health care professional to whom you refer a patient is accountable to a statutory regulatory body…’.

Access to service is rapid with appointments typically being available within forty-eight hours of initial contact with a Chiropractic clinic.

Chiropractic is only available on the NHS if PCTs or similar have contracts with them.

Chiropractic is inherently a safe treatment choice for most patients.

Serious side effects of care are rare with the most widely documented being a basilar arterial stroke – frequency of 1 in 1 million manipulations

More commonly patients may feel soreness or stiffness following initial treatments.  This typically eases within 24 hours.

Meta-analysis by The Royal College of General Practitioners for their ‘Clinical Guidelines for the Management of Acute Back Pain’ confirms that manipulation is safe in skilled hands, mentioning specifically chiropractic, osteopathy and specialist physiotherapy.

Who should I consider recommending to a chiropractor?

There is strong research evidence in the literature for the benefit of chiropractic for:

  • Lower back pain
  • Neck pain
  • Whiplash type trauma in the absence of frank tissue damage.
  • Tension headaches

There is weaker evidence of benefit in:

  • Asthma
  • Digestive disorders
  • Migraine
  • Infantile colic
  • Menstrual pains

How much treatment is required?

Typically acute problems require 3 to 6 treatments whilst chronic ones would expect to be seen 6 to 12 times.

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Recommended further reading:

ABC of complementary medicine: The manipulative therapies: Osteopathy and Chiropractic. Andrew Vickers and Catherine Zollman. BMJ 1999; 319: 1176-1179 http://bmj.bmjjournals.com/cgi/content/full/319/7218/1176  

National Institute of Clinical Excellence draft guidelines on Low Back Pain http://www.nice.org.uk/guidance/index.jsp?action=folder&o=42249

For more information about chiropractic please contact: Back2Health (2 Charles Street, Petersfield, Hants GU32 3EH, Tel: 01730 267423), or the General Chiropractic Council, 3rd Floor North, 344-354 Gray's Inn Road, London WC1X 8BP. Tel: 0171 713 5155 

The GCC have asked us to remind General Practitioners that further guidance from the GCC on referrals and other professional issues may be found at www.gmc-uk.org.

This information is produced and published by Back2Health. We gratefully acknowledge the comments provided by the GCC and the GMC during its design.

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© November, 2008 - Back2Health Group